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HomeMy WebLinkAboutSWANSON LT 1Swanson Lot 1 #051-221-37 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ay::21&0 PID Number: Name: ater System: ❑ New ❑ Upgrade Address. ABSORPTION FIELD PODeepTrench Phone: g' No. or Bedrooms: Shallow Trench ❑ Bed ❑ Mound El Other LEGAL DESCRIPTION 1.02 Total Depth orialnal grade: GPD/S Ft. .m G. lot: / Block: Subdivision- Depth to pipe bollnm from original grade: X. ea Gravel depth beneath pipe rS w .e! Ft. Ft. Township: Range: Section: Fill added above orioinal grade: Gravel length: 191AIIMM-1-1 ;X A_T_. Ft. aw Ft. • WELL: XNew 1:1 Upgrade Gravel width: . Number of lines: Dish/oh een ones: tV L� Ft. Ft Classdicano n .B.CI: Total Depth: Cased To: Total absorption area: . Pipe malarial: Ft. Ft. S + G Ft. Dn1IeC Date Drilled: Static Water Level: Installer: Date Installed: A tJ 9 Ft. /L%` 2001 Yield: IQ Pump Set at: Casing HeightAboveGround: TANK GPM FI. Ft. SEPARATION DISTANCES Xseptic ❑Holding 0S.T.E.P. To Septic Absorption Lot Hokiirp ubuNPrwale Manufacturer. Capacity In gallons: From Tank Field Station Tank Sewer Lines ✓`/ 42 Well 1-flO ' /i^•e /v//f f�OQa ,1 �I./ 't Material: Number of Compartments: 77 �0 G .2 Surface Water +/e0 ' f/vo' tIw1 LIFT STATION Lot, Line ele � t12� A Size In gallons: Manufacturer: Foundation e F D "Pump on" level al: poll" level at: High water alarm at: Curtain I Drain /�� Pump!!!odel I Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: N B I Assumed Elevation: E Z-.4 U q� MTKE GLh�l2E CD'"Qiak T,�S!,tu,,lrbA,) �; Inspections performed by: 6102 co(4PL ^aN>- < 22�) Dates: 1st 2nd cflrostMERRWooD ,- Department of Health and Human Services approval� CE- j Reviewed and approved by: A%• Date: ' 0 ssia1A. 72-013 (Rev well MOA 25 Permit No. SWO10059 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1. SWANSON SUBDIVISION PID No.: 051-221-37 N89.57'03'W 434.58' SWNG TIES .3• tiry , C 23.5 a.r y'h ti •,.r 2a.x' ,yb �o r TMy O h 6� fir. ..:,DRNEWAY" �, f D TAT CC n rd WELL . Dl n r m` ¢ . r, '•�. 1.230 CAL s �C TANK HOUSEA SCALE 1' ' 80' 41* . )* v ® - TEST HOLE �I ;^ • — MONITOR TUBE o — SEWER CLEAN OUT + — WELL S89'58'01'E 279.86' - EASEMENT - — - - LEACH FIELD ® - DRIVEWAY 8/4/04 ELEVATIONS ENGINEER'S SEAL 0000000 (NOT TO SCALE) o� OF q��opo Ce GF CONCRETE PAD BELOW STAIRS p ,`�•...•• q Q ASSUMED ELEV •100.0' aRIGINAL GROUND TEST HOLE AN 2- • .S�OO LEVEL AT 101.0' 2• INSULATION 99.3 99.3' Q � 4. QO IIIQ.... ... . .. .... .. D ff q0W'9 _35' ..................... . -)0-',CHRISTOPHER WOOD O TANK 9. OQ �f•'• CE-10387 OO 973, ?2.8' Z8' 86.5' Na GVT o04�440••,,__QQ o Eagle River Engineering ,Services Christopher R. Wood, P. 10421 VFW Road Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax August 4, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Swanson Lot 1 As -built and HAA Approval Dear Mr. Roth: The contractor who installed the above referenced property's septic system has informed ERES that he placed 1.5'-2' of fill above original grade. Please see our revised inspection reports reflecting this information. Additionally, we have shown the reserve septic area on the as -built plan. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIV ENG E G RVICES Christopher R. Wood, P.E. Principal \2003\04-053SEPTICNARRATI V E.DOC MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Apr 10, 2001 Expiration Date: Apr 10, 2002 Permit Number: SWO10059 Parcel ID: 051-221-37 Legal Description: 'SWANSON LT 1 Design Engineer: 0024 Eagle River Engineering Services Site Address: Owner Name: Troy & Marcia Weicht Lot Size: 113325 SO. FT. Owner Address: 18134 Poplar #1 Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: ❑-1 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Y' /D " 0 / Date: 4—/Q —0/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 057 — 2 2.1 — 3 7 Permit Number SWO/001*9 i Propertyowner(s) DyZ ' k,-aAC-Te_yT Daypho,�ne Mailing address (1) /8/-30/ tPoozgR"1 CkGf6zsg,- R, Mailing address (2) Zip Code y95—A Legal description (Lot, Block & Sub'd.) -5WAAI.Sp�(/ -SV9, Z07 - Legal description (Section, Township & Range) Lot Size 113 ,325' Acres q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Ell� Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. V- t1-01 owner or authorized agent) Permit Fees: � 3 Z 0. O n Waiver Fees: Date of Payment: — ",OJ� Date of Payment: Receipt Number: ��3_( Receipt Number: (Rev. 12100) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Sox 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW000370 Legal Description: SWANSON LT 1 Design Engineer: 0024 Eagle River Engineering Services Owner Name: Troy & Marcia Weicht Owner Address: 18134 Poplar #1 Chugiak , AK 99567 - Date Issued: Sep 12, 2000 Expiration Date: Sep 12, 2001 Parcel ID: 051-221-37 Site Address: Lot Size: 113325 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q✓ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343.4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. UPON COMPLETION OF CONSTRUCTION OF THE PROPOSED WATER WELL AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, A SANITARY SEAL SHALL BE INSTALLED ON THE WELL CASING WITHOUT A PUMP OR PITLESS ADAPTOR CONSTRUCTED UNTIL A WASTEWATER PERMIT HAS BEEN OBTAINED FROM THIS DEPARTMENT. Received By: Date: Issued By: /._/ ht��(,� V. / �L` Dale: 9— Z — e MUNICIPALITY OF ANCHORAGE D.p.runent of '/W.0 t'Iafth JE Flt+narr Sorvk:e. Dr►slt. sewerrnr n wr+nn AppUu . QS I — a a I— 3 7 N= AAAMdan Butt be 9W W ewOrAly SINGLE FAMILY DWELLING Pcow bwtfkzon Nc~ Property Owner Name �L to ✓ . Day Phone &9A— S/ 9 7 Malling Address I cAl 3 Rehr I lam/ mil t zip code !R q -S & 7 Legal Description I "S'W 0 rLSD n 6.m. w. ra ww Lot Slze -=Cy✓ > '-L' wZq. Ft. Number of Bedrooms Inspections will be conducted by: QPpproved Engineering Firm ❑ Municipality (per nft fee Included) Does your house contain any of the following: ❑ Hot Tub ❑ Swimming Pod ❑ Therapy Pool ❑ JacuzzJ ❑ Water Softener Unit This application is for. ❑ Sewer Only %Sewer and Weil ❑ Sewer Upgrade ❑ WOII Only ❑ Water Storage 1 certify that the above Information Is correct I further certify that this application Is being made for a Sinpl. Family Dweli ft and In accordance with appGcabie Municipal Codes. owrwlWa Dr#W Fees: Recept Walver Faes PA010 f '� f 72-012 (Pb M)' Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577-3294 August 25, 2000 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 1 Swanson Subdivision Narrative & Permit Application Dear Mr. Cross: (907)694-5195 tel (907) 694-3297 fax The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are very large, allowing sufficient room for septic sites as there are no conflicts with well separation. 2. Immediate neighboring septic systems are all +30' distance. The soil is excellent. 4. Drainage will not be affected and is not a major consideration in our design. Due to the topography of the lot we have designed the primary system at 45' from the top of a +25% slope and the reserve at 35' from top of slope. Although this is less than the required code separation distance we are asking for a variance as we feel the reduction in separation distance will not cause a surfacing of effluent or any detrimental effects. The system is aligned to have only the far end facing the slope and the slope is naturally vegetated. If you have any questions please call our office at 694-5195. Sincerely, Louis Butem, P.E. \1997199 -027 -spec Eagle River Engineering Seg vices Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577-3294 (907) 694-5195 tel (907) 693-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 1, Swanson Subdv. August 25, 2000 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1250 gallon minimum, MOA approved tank. C. DRAINFIELD I. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom in the area of excavation. 2. The bottom of the open trench excavation shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 7' at any point along length of trench. 4. The 4" effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of mounded soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. S. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH= T GRAVEL DEPTH = 4' under pipe, 2" over pipe TRENCH LENGTH = 50' TRENCH WIDTH = 5' SOIL RATING= 1.2 GPD/ft2 BEDROOM CAPACITY= 4 SEPTIC TANK = 1250 GAL. Twenty-four (24) hours notice required for all inspections. 11997.99 -027 -spec NE 1/4• SE 1/4, SE 1/4 1tlo ••0s a sect;cs No wells I • I I p3 tee I �• No se0t;cs +100' No wale I � I eBTM� n � I ' it L — ' i. Rsurw Sw 15E .1SE /4 SE LOT 1 „ } I ��` dela / 4 9rwN OE q / ¢o 0 WiI Lech field i. yi�R�.OQ�� 49rol 1 ;r r 40' wells +100' Septics +30' LOT 3 NO SURFACE WATER NO KNOWN CURTAIN DRAINS i n wells +100' SooNcs +30' 1 I ® — TEST HOLE • — MONITOR TUBE o — SEWER CLEAN OUT ¢ — WELL -- -- — EASEMENT — PROPOSED LEACH FIELD — EXISTING LEACH FIELD D — Driveway ® — Deck WELL SEPTIC SITE PLAN LEGAL: LOT 1, SWANSON SUBDIVISION OWNER: TROY WEICHT CONTRACTOR: N/A JOB 99-027 1 DATE: 8-24-001 SCALE 1 "= 100' EACLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3295 OF 49 TH *' j LOUIS A. BUTERA It W. ��i7 s% CE -6736 OII III I�HSS\ON EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 99-027 Calculated By: LB Date: 8/24/00 Legal: Swanson Lot 1 Single Family 4 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field TEST HOLE 1 Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 1 minutes per inch Wastewater application rate = 1.2 gallons per day per square foot Required absorption area = 500 square feet Trench width (W) = 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor= 0.50 Total Excavation Depth = 7.0 feet Required length = 50 feet 49 rH ••.v, LOUIS A. BUTERA : IN CE -6736 •' id0 � PROF ESStO�� 99-027bspc 4:46 PM8/24/00 e it Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:_ i✓c/WT DATE PER LEGAL DESCRIPTION: Lcr / _ ✓/a[aA/S-v./ ZQQ-„vS,,.Township, Range, Section: 7/_ ,Q,w 1,7 %y / '7Z1� �� 'c.a..twG • SLOPE SITE PLAN 1 C7e<i �/�G LGYF�- 2 n Paas/¢<a N 3 ' 4 6- 7- 8- 9 78 9 10-4 -, IF] ellei W, 12 e c-7- G2r s A, V,L4�4 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? A) 0 S L O P E Depth to Water After Monitoring? 4 Bait 4 Reading Date Gross Time Net Time Depth to Water Not Drop N• Sn.i/ �/7n.�ix 20 -{ I „ IL_ JI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER � L/ TEST RUN BETWEEN FT AND FT COMMENTS- ���-.;1' �r.LF /✓a /ai ,-/fti PERFORMED BY: c ve = I;��t d CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 6 /4 72-008 (Rev. 4,85) .., Municlpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:'T it�c i�./T- DATE PER LEGAL DESCRIPTION: wr /y S.toyt-,.r Z .q,,,,,g5,,JOWnShiP, Range, Section: %�I2 Er TL�Sa� SLOPE 1 w 6i 2 J vrt 3 Plf 4 .;-n w 5 SP i 6- .54n/D Hlr T1J 7 Linc' L.m:X 8- toto- ..�...'r/p W/ Sie7- 12- 13- 14 1213 14 15 16 17 18 19 20 WASGROUND WATER ENCOUNTERED? /Vi IF YES, AT WHAT DEPTH? Depth to Water After Monitarinp] Wt Data J 4 ReadingData Grote Time Not Time Depth to Water Net Drop TEST RUN BETWEEN �� FT AND FT COMMENTS —77- r lv.,•v 2 ?t'41 O.. Al in s PERFORMED BY: E•�>4 .C,vd7E��>rw�L�7Lr✓[� I I -S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.�O c1r' 72.008 (Rev. 4/851 uPERCOLATION RATE L (minutevincn) PERC HOLE DIAMETER TEST RUN BETWEEN �� FT AND FT COMMENTS —77- r lv.,•v 2 - /1.. /r/-;' PERFORMED BY: E•�>4 .C,vd7E��>rw�L�7Lr✓[� I I -S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.�O c1r' 72.008 (Rev. 4/851 �1 Permit Number: SW000370 MUNICIPALITY OF ANCHORAGE Department of Heafth and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Sep 12, 2000 Expiration Date: Sep 12, 2001 Parcel ID: 051-221-37 Legal Description: SWANSON LT 1 Design Engineer: 0024 Eagle River Engineering Services Site Address: Owner Name: Troy & Marcia Weicht Lot Size: 113325 SO. FT. Owner Address: 18134 Poplar #1 Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank Holding Tank [:] Privy O Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 15."The following special provisions. q_ UPON COMPLETION OF CONSTRUCTION OF THE PROPOSED WATER WELL AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, A SANITARY SEAL SHALL BE INSTALLED ON THE WELL CASING WITHOUT A PUMP OR PITLESS ADAPTOR CONSTRUCTED UNTIL A WASTEWATER PERMIT HAS BEEN OBTAINED FROM THIS DEPARTMENT. Received By: Issued By: Date: _I Z— 00 Date: —12 -'42 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577-3293 August 25, 2000 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 1 Swanson Subdivision Narrative R. Permit Application Dear Mr. Cross: (907) 694-5195 tel (907)694-3297 fax The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are very large, allowing sufficient room for septic sites as there are no conflicts with well separation. 2. Immediate neighboring septic systems are all +30' distance. 3. The soil is excellent. 4. Drainage will not be affected and is not a major consideration in our design. Due to the topography of the lot we have designed the primary system at 45' from the top of a +25% slope and the reserve at 35' from top of slope. Although this is less than the required code separation distance we are asking for a variance as we feel the reduction in separation distance will not cause a surfacing of effluent or any detrimental effects. The system is aligned to have only the far end facing the slope and the slope is naturally vegetated. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997\99.027-sprC Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 1, Swanson Subdv. August 25, 2000 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. S. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1250 gallon minimum, MOA approved tank. C. DRAINFIELD 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom in the area of excavation. 2. The bottom of the open trench excavation shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 7' at any point along length of trench. 4. The 4" effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of mounded soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. S. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 7' GRAVEL DEPTH = 4' under pipe, 2" over pipe TRENCII LENGTII = 50' TRENCH WIDTI I = 5' SOIL RATING = 1.2 GPD/R2 BEDROOM CAPACITY= 4 SEPTIC TANK = 1250 GAL. Twenty-four (24) hours notice required for all inspections. 11997\99 -027 -spec NE 1/+, SE 1/4, SE 1/+ NNoo wens or ssp6cs ons Wells +100' Septics +30' LOT 3 M1M1 7 y H o Wells +100', Septics +30 1 I ® — TEST HOLE • — MONITOR TUBE 0 — SEWER CLEAN OUT 4 — WELL -- -- — EASEMENT PROPOSED LEACH FIELD — EXISTING LEACH FIELD NO SURFACE WATER Driveway NO KNOWN CURTAIN DRAINS ®— Deck WELL/SEPTIC SITE PLAN LEGAL: LOT 1, SWANSON SUBDIVISION OWNER: TROY WEICHT CONTRACTOR: N A JOB# 99-027 1 DATE: 8-24-00 1 SCALE 1"= 100 EACLE RIVER ENGINEERING SERVICES P.O. Box 773294 EACLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3295 OF * :49TH* .Py�.. . ...... .. 4 0 � LOUIS A. BUTERA fir. r/ '.r CE -6736_ It�?FESSt�! . I • 1 I ,tr No s +100 ' wells wel No welb ^ r I iMt It I s' SIN SE4. 1SE 1/+ lZ lZ / Y. I ` LOT 1 `sures ' I \ \ Y 1P 9ro�vel ^ E.7s0ng V I toaoo--�5. Ljocn field .°ow n ppssd ar b^9 Well 1 Wells +100' Septics +30' LOT 3 M1M1 7 y H o Wells +100', Septics +30 1 I ® — TEST HOLE • — MONITOR TUBE 0 — SEWER CLEAN OUT 4 — WELL -- -- — EASEMENT PROPOSED LEACH FIELD — EXISTING LEACH FIELD NO SURFACE WATER Driveway NO KNOWN CURTAIN DRAINS ®— Deck WELL/SEPTIC SITE PLAN LEGAL: LOT 1, SWANSON SUBDIVISION OWNER: TROY WEICHT CONTRACTOR: N A JOB# 99-027 1 DATE: 8-24-00 1 SCALE 1"= 100 EACLE RIVER ENGINEERING SERVICES P.O. Box 773294 EACLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3295 OF * :49TH* .Py�.. . ...... .. 4 0 � LOUIS A. BUTERA fir. r/ '.r CE -6736_ It�?FESSt�! G MunicipalityEA of Anchorage de••~� —... DEPARTMENT OF HEALTH 8 HUMAN SERVICES Louis . Bd rIt 825'L" Street, Anchorage, Alaska 99502-0650 `•yam'. ~ L°°Is A Butar+ ' SOILS LOG — PERCOLATION TEST �4e.�._ ..��• PERFORMED FOR: 'TG A&_'e'/ 7 DATE PERFORMEO:."41v 9/I94 LEGAL DESCRIPTION: dor /�'S• �,an,rsavTownship, Range, Section: T,r�. ,Q,r,/ , r r.7 EME]TN SLOPE SITE PLAN 1 Gv a . e /b�VeL fast N 2 u Gteolzm t At 3- 4- 6. 46 J• 7 u u o 6 ' 8 a 9 0 :o J • O • o it13 _ 12 �' -, 14 15 16 17 18 19 20 J��- Sl✓ ScND wrn/ be.. y to,osr WAS GROUND WATER u P ENCOUNTERED? S SAn z, qo W/ IF YES, AT WHAT L O Sr S01-7-DEPTH?P E -Nst Depot to Water ARK MaliWllg7 �.�t-o+l� �-a 7-97 Reading Data Gro. Timet Net Time Depth to Water Net Drop .. PERCOLATION RATE � Iminutesiinch) PERC HOLE DIAMETER d TEST RUN BETWEEN $" FT AND ` FT COMMENTS r�Sl N�r..�i /+rw h -i,:,/ 0... /.iii ei r...v✓ `/it.w PERFORMED BY: E22CIL ',Vdw_v 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE S — .2'g "' 72-008 IF". 4,a5) 4. 1 r•'�'4 �4 •` v Munklpailfy of Anchorage � ����� �_�... •• DEPARTMENT OF HEALTH & HUMAN SERVICES' • t 625 "L" Street, Anchorage, Alaska 99502-0650 b`Y �1 Louis era f= r SOILS LOG — PERCOLATION TEST �v�;�aa.. _..•.r PERFORMED FOR: iflc/UT DATE PER FORMED:E_Kl4/f9g LEGAL DESCRIPTION: Lcr /��t.�iarn,✓rSavTOWRShip, Range, Section: T/.moi✓, ,¢, h/, Src /7 7Ly.Scs SLOPE SITE PLAN S- 0 ° SP 6 G.z4t.FL 7 o 6 0' s. g � J 10 — SnvO hw/ Sic T 11 &AA N 12 r •, 13 14 16 16 17 16 19 WAS GROUND WATER ENCOUNTERED? /V {• a IF YES. AT WHAT L DEPTH? p E 11"M to WaW Mar Manaltruy? dr t not _.. Flooding pan Groaa Time �- 1 o`e Gr p'' C v°✓ 3 e 4 S- 0 ° SP 6 G.z4t.FL 7 o 6 0' s. g � J 10 — SnvO hw/ Sic T 11 &AA N 12 r •, 13 14 16 16 17 16 19 WAS GROUND WATER ENCOUNTERED? /V {• a IF YES. AT WHAT L DEPTH? p E 11"M to WaW Mar Manaltruy? dr t not _.. Flooding pan Groaa Time Not Time Depth to Water Not Drop 20 { IL_ JI PERCOLATION RATE 41 tminuteLmehl PEAC MOLE DIAMETER 6 TEST RUN BETWEENy FTAND S FT COMMENTS ?Z yli..[/fi. w! ..(».i ✓//�� PERFORMED BY: JSZC [Lc Qydv—, I�7.�r` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. cr— — 2c —Gd 72-0081Rer. 4,851 (iex#'If itb xtX C�xt r by DOC Co. m. SULLI VAN WATER WEL ,. E I V E b P.O. BOX 670272, CHUGIAK. ALASKA 99567 TELEPHONE 688-2759 OCT 03 20 MI 00 OWNER OF LAND 1 IQO Y .z 114)261 A W EIC /i%BORE HOLE DATA M, . r AnChorap9 ADDRESS I �l.7y �OPlgfc �'/( 16i DEPTH Dept ., v HumanServlcese LEGAL BESCRIPTION Y1,J q J Sc� aT O GI r4 S r,J 6 /GrIJ !" • PERMIT NUMBER UOO3 % 0 Date of Issue TAX INDENTIFICATION NUMBERQS/ - C ,2 Is well located at approved permit location? es Q No Method of Drilling: air rotary Q cable tool Depth of well: / G O Casing Type Fe L Wall Thickness S O Inches Diameter iD inches, depth C2 y feet Liner Type: /') a ,J c Casing Stickup Above Ground: 49 • feet Static Water Level (from ground level): :7e feet Pumping level:—feet after hrs. pumping _gpm Recover Rate: 10 Opm Method of Testing: Al Q• Well Intake Opening Type: Q Open End (y)repen Hole Q Screened; Start feet Stopped feet ❑ Perforations Start jestopped feet Grout Type: /SFiu " W ' TL' VO(u/me 15'0 C �3 r• Depth: from feet, to feet Pump Intake Depth: feet Pump Size hp Brand Name Well Disinfected Upon Completion? OWes Qe No Method of Disinfection: CA �C,.Jc � o/ "m Comments: 7//9/Q 000 0J4,70- 9Jr(4A50-j i SAAJo GRAJ.= 2GadrJ�cS UJA.c i L sr4� r �) �3�•O,txK GKEE.J �� c t GRc �1 QJ 4,c r: I E-,J..►.t. 13 tFdx L160 i %b t zlw ac rc. 64i Eco• Drillers Name a;1e dl ' ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. rc�rrS • Municipality of Anc On -Site Water and Wastewater (907)343-7904 Certificate of On -Site Systems Parcel I.D. 051-221-37 1. GENERAL INFORMATION Complete legal description Swanson, Lot 1 TG JUN 2, 7 2 10 16 seer. ti W �h y�0168i,9 Expiration Date: /0— (3—/6 Location (site address) 18134 Bending Birch Dr. Current Property owner(s) Patricia & Robert Bozzo Day phone Mailing address Real Estate Agent PO Box 670813 Chugiak, AK 99567 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx I Individual Fx I Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5'Z6- ®O Waiver Fee $ _ Date of Payment ©/�G Date of Payment Receipt Number 075gLYG� Receipt Number COSA# Q5"G16/Z62_ Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewaterdisposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, .nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for __� bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 6/21/2016 Conditional approval for bedrooms, with the following stipulations: OF JIAtTER ithln By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel ° e If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Swanson, Lot 1 Parcel. ID: A. WELL DATA Well type Private If A', B, or C provide PWS ID # Well Log (YM) Y Date completed 9/19/2000 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 160 ft. Cased to 21'4, ft. Casing1height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 9/19/2000 6/21/201.6 Static water level 78 ft 25 fC. Well production 10 g.p.m. 5.0+ 9.p -m. WATER SAMPLE RESULTS: Collform colonies/10.0 mL Nitrate .2 mg/L Arsenic �y ,� ug/L Date of sample: 6/21/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed May 2001 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y 11 Foundation cleanout (Y/N) Y , Depression over -tank (Y/N) NHigh water alarm (Y/N) N Date of pumping l /*l01 (P-" Pumper S A'.r. C. ABSORPTION FIELD DATA May 2001 2 2 1.2 GPD/SF Shallow Trench -Date installed Soil rating (g.p:d./ft or ft /bdrm) System type Length 54 ft. Width 5 ft. Gravel below pipe 4 . ft. Total depth 8.1 fL. 'Eff, absorption area 500+ fl? Monitoring tube Y Depression over field N` 6/21 /2-01.6 Pass 4 Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test 0 In. Water added 649 gal: New depth 8 in. Elapsed Time: 290 min. Final fluid depth in. Absorption rate >_ 600+ g,p,d. N Any rejuvenatidh treatment (past 12 mo.) (Y/N & type) O If yes, give date D. LIFT STAT40N Date installed Size in gallons_ "Pump on" level at in. "Pump off' level at Datum Cycles tested Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer man holelcleanout 100+ Sewer /septic service line 25+ Holding tank _100+ Animal containment areas .50+ Manurelanimal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main `1b+ - Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parkingivehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on File - G. ENGINEER'S CERTIFICATION i certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 6/21/2016- COSA canary sheet -2-6-1 6.doc rr: Te ;:. CE -8149.. _. I caT& wocb Municipality of Anchorage • Development Services Department *A. Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 2e�' I S 5 UG Parcel I.D. OS/ -?�/ - .41 HAA # 0 D 36- C. Expiration Date: 3 - 15 -- O 1. GENERAL INFORMATION Complete -legal description Location (site address or directions) /IP l $Sf a?t ee ggfr6 pr ..Current Property owners) :222. f Vnaiuu&A Alt,L Li E Day phone terF- $77-7 Mailing address . Lending agency Mailing address Real Estate Agent Mailing Address r bW 4m&HeiA,& l � fCc Day phone !e9 N — 145'(& Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: ja Individual On-site g ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.. 91fr I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering SerAm Phone* (eq 1/- S/9S 10421 VPW , SUfte 20 Address FaelaRimr ekooc-n Engineer's Printed Name C 6STOg`/5< e. "O� > Date /02 — JS — ON 5. DSD SIGNATURE _1� Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: - - Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:a/��.� , /�• P� Original Certificate Date: (Rov. 01A7) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: r J6i1uiLP.8i2 r �ef 1 Parcel ID: 0157- a23/ � 37 A. WELL DATA Well type PyR,7((_ If A, B, or C provide PWSID # _ Well Log (?N) Date completed 20121061 Sanitary seal 191N) 0 Wires properly protectedtp/N) Total depth /.O ft. Cased to �(_ft. Casing height (above ground) �$__in. FROM WELL LOG AT INSPECTION Date of test Static water level 78 ft• .2 8 ft' Well production /D g.p.m. 3. D g.p.m. WATER SAMPLE RESULTS: Coliform Q_colonies/100 ml. Nitrate mg.A. Other bacteria 3 colonies/100 mi. Arsenic: Mg /I. Dale of sample: Collected by: S 1610OUCHA A B. SEPTICTANK DATA /Material - ��r0 �R^� Date installed 0 / Tank size JdjEo gal. Number of Compartments i Cleanoutso/N) �— Foundation cleanoutOY N) j f4 Depression over tank (Y&) `.1' B' High water alarm (Ye clGa Date of pumping / Od Pumper )k IS ^ e C. ABSORPTION FIELD DATA Date installed x S / Soil rating (g�d�r f?/bdrm) La System type ?rt,an1r - Length -54- ft. Width S ft. Gravel below pipe 4 ft. Total depth 5_ ft. Eff. absorption area 50D ft� Monitoring tube q7 Date over field Date of adequacy test GZLIVI t Results (1!WOFail) ,j�a For * bedrooms Fluid depth in absorption field before test d-,:� in. Water added 600 gal. New depth in. Elapsed Time:. min. Final fluid depth /!L in. Absorption rate >= (.00 g.p.d. Any rejuvenation treatment (past 12 mo.) (YAO & type) moi/ Prt.er If yes, give date ti D. LIFT STATION Date installed "Pump on' level at _ in. E. SEPARATION DISTANCES Size in in. High water alarm level at Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1140 On adjacent lots +/00' Absorption field on lot /,Y8 On adjacent lots -t /M Public sewer main + 7S / Public sewer manhole/cleanout +' /00 r Sewer/septic service line t�5 r Holding tank r /Go r SEPARATION DISTANCES FROM SEPTICS TANK ON LOT TO: Building foundation /a Property line 179" Absorption field P t Water main .r /n ' Water service line -t /0 r Surface water Wells on adjacent lots + /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I Building foundation ZP r Water main +-/O r Water Service line + 10' Surface water +100, Driveway, parking/vehicle storage 't"/0 r r Curtain drain + 5+0 Wells on adjacent lots +/00 Gi /Vons knoWIn . F. COMMENTS G. ENGINEER'S CERTIFICATION in. I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. / = Ct�1310PFffRRWD t7p Engineer's Printed Name `�2iL�7DD�iar Q. Gt%19c1 ,1£ .' Date X�lvr. fir, 1,704 HAA Fee Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage -� Development Services Department *A4 Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ` www.ci.anchorage.ak.us( J\ (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. L`)S/- XX / S HAA #-- �3 ,y Expiration Dat , _ 1. GENERAL INFORMATION Complete legal description ��✓.�r�s�, ✓ .cdr l Location (site address or directions) Ayiad e!!1L!4/AC Current Property owner(s)- 7 k2 &.o i ti1,9,re-�y«.t .G�,rArDay phone ,Mailing address11yzx.AG .44 �s -.Lending igdncy Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System INETWInj ..Day phone _— Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firms�� „siz ��6 �dc� Phone Addressl�_-_,71 1it!/ ,eo. Z-04rG '4& �9Si7 Engineer's Printed Name :: v, r2,nmye- G' /,&dn Date _Z3 atA147_oo� 5. DSD SIGNATURE Approved for —It— bedrooms. Disapproved. Conditional approval for - bedrooms, with the following stipulations: - Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By � Original Certificate-Date:—Iq=-1-/-- OJ74— (Rw. OIJ021 Municipality of Anchorage * Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. ' P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .�t t!s4Lr/ ,/ Parcelll): A. WELL DATA Well type _,arjw.4,4 ' If A, B, or C provide PWSID # Date completed Sanitary seaIA) Total depth (1.e- ft. p.m- Cased to 4?/ --ft. FROM WELL LOG Date of test !eeQq /4042 Static water level 78' ft. Well production 10 J 9— WATER SAMPLE RESULTS Coliform colonies/100 ml. Arsenic: mg.A. mg.A. B. SEPTICfftMM= TANK DATA Nitrate 49 mg.A. Well Lo&) wigs Wires property p) t/'tyr Casing height (above ground) _/Tin. AT INSPECTION S. el 9— p.m- Other bacteria / colonies/100 ml. Date of sample: Collected by: gap.,,- rjmrTp wst nal Amcd, 7*1r- Date installed *Pkt*. SIC>I Tanks¢e /Xd2) 'gal. Number of Compartments Z Cleanouts®N) y6'J FoundationcleanoutgM 4ey!:S Depression over tank (Y69 Ivo High water alarm (Ydo .aM Date of pumping 4&e 14x Pumper %7015 Q ABSORPTION FIELD DATA Date installed ��0 j Soil rating .p.d. or ft=Abdrm) _,&.Z Length .'l'y ft. Width _Jr-- ft. System type TE6.ua.v Gravel below pipe _L ft. Total depth 4T ft. Eff. absorption area -&eLfe Monitoring tube ygr Depression over field Al Date of adequacy test 4z= Z'ov Result435; Fain 4tFor-4 bedrooms Fluid depth in absorption field before test Z&f in. Water added 400 gal. New depth in. Elapsed Time:.t':f�min. Final fluid deptt09�n. Absorption rate >= t'vOD g.p.d. Any rejuvenation treatment (past 12 mo.) Mu type) "Owe If yes, give date N1* D. LIFT STATION Date installed 'Pump on" level at_ in. Datum E. SEPARATION DISTANCES Size in gallons 1 'Pum at _ in. tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /'YO Absorption field on lot Public sewer main Sewer /septic service line •f alS (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots 't /tlG ' On adjacent lots -r/do / Public sewer manhole/cleanout .1 �� r Holding tank -eivo ' SEPARATION DISTANCES FROM SEPTIC/MSG TANK ON LOT TO: Building foundation /.2 Property line � � Absorption field Ir � Water main 7�/D ' Water service line +/0' Surface water t/Od ' Wells on adjacent lots s/sD r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation R r' Water main t/O' Water Service line iW ' Surface water '%/OD ' Driveway, parkingivehide storage t/M' Curtain drain 7 SD .1 Wells on adjacent lots T~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name CHRTSRftex R. to i t> S[OPlERIt Date Z3 .,r t4i-� 2r9r)ce t ''.,ry ClEdw HAA Fee E i 0 Date of Paymentf Receipt Number 5533 ✓n� (Rev. 12(01) Waiver Fee $ Date of Payment Receipt Number in. k Municipality of Anchorage Development Services Department Building Safety DivisionOnsite Wpter and Wastewater Program4700 *At F South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us r (907) 343-7904 ON-SITE SEWER/WELLSUBMITTAL COMMENT SHEET To Chris Wood g . Legal description: Swenson Lot 1 The attached paperwork -has -been reviewed and is being returned for the following reasons: ❑ Q0Q1.oal slgnaxure cr stamp missing on i� .t�iian<@Crorinde�)�nt,_ ' G' Atldjiignal ods id0llr On needed ❑' Water, rnonitoringMulls inadequate, ® Riscrep nCyininformotionaybmitted. S stetl► too deepor test hole t ❑ Tflpographic infortnaiion missing or Inadequate 4, dncgmplete; mlts�rtgJ2esetve•trenth not shown: ❑ :InCQmplQto; rrtisoln�,�,; ❑ :>1it16Jt816d$�1v1t$x Inforhlation needed .: ❑ • IIICAtersample u6g�S,72�a-41e.:-,.,.r, .: utedlprtsaQg4As't�c�s_111Uoerisio4s mis.�lgf . �@t� . f.�rif�1'� Qr1�f]A yvtil@rtQ2R1tQ�I�:1-iTA s.11ff� ..,�.., rRL�s>Yteor-e;; ir�fatiaom, �CSirtis.71 min c) -sr - Woo. Jn�uf�etent=fill����an�tol�t�ld ' 2..,_ Name of reviewer 7-4-, 04_ Please supply the necessary'information an41 rersubmit your requs t LEAVE THIS AORM ATTACHED TO: THE PAPL=RIr' WORK R" �4 N a M iYB�'� bi w Z�9, BG ASBUILT HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY= rru�tvlo.✓ fG� cor/ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. S97ARD & ASSOCIATES LAND SURVEYING 69 SCALES o' OF At R� DATE= r �Q •. .5,�� GRIDt�a�S� } `7ji Duo"* Merk S.We d FB*/oS /o ���b�.'. LS -6918 a c+4 DRAWN TA -awl xu1